Background/Purpose: It is recommended that management of rheumatoid arthritis (RA) requires regular quantitative assessment of RA activity. Treat to target management could be facilitated by use of smartphone applications (“apps”) for input, storage, and transmission of validated RA disease activity measures. These data could be used by rheumatologists in clinical practice or by people with RA. However, potential users of apps must have confidence in app quality. This review assesses the functionality and quality of apps for RA disease activity monitoring by: 1) systematically identifying apps for monitoring of RA; 2) summarizing and comparing features to RA disease activity monitoring guidelines; and 3) rating app quality according to the recently developed Mobile App Rating Scale (MARS)¹.

Methods: A systematic search of the Google Play and iTunes stores was conducted to identify smartphone apps designed for measurement of RA disease activity by people with RA and rheumatologists. Apps were excluded if: 1) content was for information, education, or reference only; 2) for use by clinicians only: 3) only included treatment algorithms; or 4) were not in English. Android and iOS Apps were downloaded to smartphones and features/functionality described then apps rated by two independent reviewers using the MARS. App features were compared with EULAR and ACR recommendations for monitoring of RA disease activity.

Results: The search identified 721 apps in the Google Play store and 216 in iTunes store, of which 19 unique apps met criteria for inclusion (16 Google play, 11 iTunes store, 8 both). Fourteen apps included at least one validated instrument for measurement of RA disease activity. Eleven apps allowed users to enter a joint count (homunculus n=4, number of joints n=7). Eight of these apps used the standard 28 swollen and tender joint count and functioned as composite disease activity (CDA) calculators, with no capacity to store data. Eight apps included at least one ACR/EULAR recommended RA CDA measure but only one provided the formula for calculation. Ten apps included data recording, storage, and retrieval. Only one app, Arthritis Power, included both a RA CDA measure and tracked data but this app did not include the standard 28 joint count. The median MARS score for apps was 3.41 (maximum 5). Of the five apps which scored >4/5 on the MARS rating, only one included a CDA score endorsed by ACR/EULAR but this app did not have a data tracking function.

Conclusion: No current apps for RA have functionality for entry of validated disease activity instruments, composite disease activity measures including 28 joint counts, and allow tracking of these data. Current apps are configured as calculators for rheumatologists or tracking tools for people with RA. The latter do not uniformly collect data using validated instruments. Apps which were higher quality according to the MARS collected only patient reported outcomes. Collaboration between rheumatologists, people with RA, app developers and health systems is required to develop appropriate, high quality apps for use by rheumatologists and people with RA in co-management of RA. 1. Stoyanov et al. JMIR Mhealth Uhealth. 2015;3(1):e27–9.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-systematic-review-of-smartphone-applications-for-measuring-and-recording-rheumatoid-arthritis-disease-activity/